A comparison of the predictive validity of the combination of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and other risk scoring systems for intravenous immunoglobulin (ivig)-resistance in Kawasaki disease

• Published in: PloS one Vol. 12; no. 5; p. e0176957
• Main Authors: Takeshita, Seiichiro, Kanai, Takashi, Kawamura, Yoichi, Yoshida, Yusuke, Nonoyama, Shigeaki
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.05.2017; Public Library of Science (PLoS)
• Subjects: Acute phase proteins; Acute phase substances; Age; Alanine; Alanine transaminase; Albumin; Analysis; Antagonists; Arches; Aspartate aminotransferase; Aspirin; Bacteria; Bilirubin; Biology and Life Sciences; Biomarkers; Blood; Blood Cell Count - methods; Blood cells; Blood Platelets; Bone marrow; Bone marrow transplantation; C-reactive protein; Cancer; Care and treatment; Children; Computer programs; Coronary vessels; Defensive behavior; Development and progression; Diagnosis; Drug Resistance; Female; Fever; Health aspects; Health risks; Humans; Hypersensitivity; Illnesses; Immunoglobulins; Immunoglobulins, Intravenous - therapeutic use; Immunologic Factors - therapeutic use; Immunology; Incidence; Indicators; Infant; Infections; Inflammation; Influence; Interferon; Interleukin 1; Kawasaki disease; Kawasaki syndrome; Laboratories; Lesions; Lymphocytes; Male; Mathematical analysis; Medical diagnosis; Medical prognosis; Medicine and Health Sciences; Monoclonal antibodies; Mucocutaneous Lymph Node Syndrome - blood; Mucocutaneous Lymph Node Syndrome - diagnosis; Mucocutaneous Lymph Node Syndrome - drug therapy; Neutrophils; Nursing; Odds Ratio; Patient outcomes; Pediatrics; Platelets; Prognosis; Proteins; Ratios; Retrospective Studies; Risk; Risk Assessment; Sensitivity and Specificity; Statistical analysis; Surgical implants; Treatment Outcome; Validity; Vasculitis; Veins & arteries; Viruses; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0176957

We recently reported that the combination of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) is a novel and useful predictor of intravenous immunoglobulin (IVIG)-resistance in Kawasaki disease (KD). In the present study, to evaluate the effectiveness of the new risk score, we compared its predictive validity to that of previously reported risk scores. The laboratory records of 437 patients with KD before IVIG therapy were retrospectively analyzed, and the IVIG-responsive (n = 344) and IVIG-resistant (n = 93) patients were compared. The validity of the new score (the combination of NLR≥3.83 and PLR≥150) for predicting IVIG resistance in KD was compared to that of the Kobayashi, Egami and Sano risk scores. The new score and the Kobayashi score displayed high sensitivity (0.72 and 0.70 respectively) and specificity (0.67 and 0.68 respectively), while the Egami and Sano scores showed high specificity (0.71 and 0.81 respectively) but relatively low sensitivity (0.56 and 0.45 respectively). The odds ratios (ORs) for the new score, the Kobayashi score, the Egami score and the Sano score were 5.34 (95% confidence interval [CI] 3.22-8.85), 4.87 (95% CI 2.96-8.01), 3.14 (95% CI 1.96-5.03) and 3.53 (95% CI 2.17-5.77) respectively. The predictive validity of the combination of NLR≥3.83 and PLR≥150, which is a simple and convenient indicator, was equal to or higher than that of the other risk scores. This suggests that the new score could be a widely available marker for predicting IVIG resistance in KD.